MEMBERSHIP FORM

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* 1. I / WE WOULD LIKE TO JOIN THE FOLLOWING MEMBERSHIP LEVEL:

PLATINUM - MEMBERSHIP BENEFITS $:
From $ 100.00 and over - monthly $:

* Charitable Contribution Letter for your Income Tax Exemption.
* Membership ID and Certificate.
* Member Sticker for your car.
* Listing in the online member directory.
* Your logo and link on PWMD’s website for a period of one year - renewable.

GOLD - MEMBERSHIP BENEFITS:
From $ 50.00 to $ 99.00 – monthly $:

* Charitable Contribution Letter for your Income Tax Exemption.
* Membership ID and Certificate.
* Member Sticker for your car.
* Listing in the online member directory.
* 10% off on our Events.

SILVER - MEMBERSHIP BENEFITS:
From $ 10.00 to $ 49.00 – monthly $:

* Charitable Contribution Letter for your Income Tax Exemption.
* Membership ID and Certificate.
* Member Sticker for your car.
* Listing in the online member directory.

PLATINUM - MEMBERSHIP BENEFITS

GOLD - MEMBERSHIP BENEFITS.

SILVER - MEMBERSHIP BENEFITS

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* 2. ANSWER:

Member Name:

Address:

City / Town:

State / Province:

ZIP / Postal Code:

Country:

Member Email:

Member Phone:

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* 3. Birthday - moth / date

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* 4. DONATION

One-Time

Monthly

Semi-Annual

Annual

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* 5. AMOUNT:

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* 6. BUSINESS CREDIT CARD # - CVV

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* 7. EXP. DATE:

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* 8. AUTHORIZED BY: / Date:

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* 9. ANONIMOUS DONATION? CAN WE PUBLISH YOUR NAME?

YES

NO

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* 10. * We appreciate your monthly donation. Your noble attitude inure prosperity to you, your family and your business!
* The LORD will send a blessing on your barns and on everything you put your hand to. The LORD your God will bless you in the land he is
giving you. Deuteronomy 28:8

Thank you!

8751 Commodity Cir – suite 11 – Orlando, FL 32819 – (321) 527-4593

www.peoplewhomakeadifference.org

* This agreement may be terminated at any time with a (30) thirty-day notice by either party. Initials: